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UPON THE 



EPIDEMIC CHOLERA MORBUS 



OBSERVED 



AT WARSAW, 



BY Dr. o. a. binaghi. 



TRANSLATES FROM THE ITALIAN, 



By WILLIAM SAMPSON, Esq. 



NEW-YORK: 

PETER HILL, 94 BROADWAY. 



1832. 



*» <# V. 













Entered according to the Act of Congress, in the year 1832, by Peter Hill, in the Clerk's 
Offiee of the District Court of the Southern Districtof New- York. 



//J/ 



GEORGE P. SCOTT AND CO. 

PRINTERS, CORNER OF ANN AND NASSAU STREETS. 



OPINION 

UPON THE EPIDEMIC CHOLERA MORBUS. 



TJBI NATURA DEEST, ARS NULLA. 



In publishing my opinion touching this epidemical distem- 
per, I have no other object in view than that of medicine itself, 
viz : to be useful. 

Confining myself to this sole object, I hold it superfluous to 
deduce the history of this disease, or to repeat what has been so 
often said ; and therefore, instead of offering a minute description 
of it, I shall only state it from such principal and leading facts 
which have been observed, and use no arguments beyond 
what may serve to excite attention and support the inferences 
which are drawn from positive facts; therefore without further 
preface I shall commence by saying, that I consider this to be 
a disease of the nerves (the nervous sj'stem being that primari- 
ly affected by it) and principally of the nerveo-splanchnic sys- 
tem. And in fact from the manner in which the alterations in 
the organic functions of life manifest themselves, as in cliylopoe- 
sis and h&matopoesis, it is clearly apparent to every medical 
person, that it is a disease which shows itself under the form of 
dyspnoea, vomiting, diarrhoea, alteration of the pulse, suspen- 
sion of the secretions, restlessness, general uneasiness, Sic. &c. 
And whence comes all this ? Is it not that the centre of action, on 
which depend all the vital functions, especially the organical, is 
struggling to free itself from an extraneous and excessive 
stimulus, in its nature quite contrary to the organic system, and 
destructive of the ordinary equilibrium of its functions ? 

To the alterations in these manifestations of the organic life, 
are joined those of the animal system, apparent from a spasmo. 
die state still increasing, and chiefly in the muscles of the face, 



4 

by which an experienced eye can readily discern the physiog- 
nomy of one attacked by the cholera; and among the more con- 
stant symptoms are to be remarked cramps, peculiarly in the 
muscles of the lower extremities : this last is one of the most 
pertinacious symptoms of the disease, and continues even 
through the paralytic period ; the cause whereof may be found 
in that state of particular vitality, if I may so express it, which 
exists by itself in the extreme divisions of the nervous and 
vascular systems ; that which is more discernible in proportion 
as the parts which constitute the organic mechanism are more 
* distant from the centre of action, as appears from the local 
nflammations that have their course without being felt or per- 
ceived through the rest of the body.* 

It is not therefore astonishing, since that cause may become 
so general as to make victims of almost all upon whom its influ- 
ence is exercised, and produces such terrible effects, and in a 
manner so sudden and so rapid, that no one has been able to 
discover any effective means of preventing its fatal consequences. 
The proof of what I have advanced is in the state of general 
paralysis into which the entire body falls from the moment in 
which the reactive powers of nature cease, which have been 
all expended in the impetuous conflict, and therefore Prof. 
Magendie has justly defined this distemper as "Maladie qui ca- 
daverise a Vinstant mime la personne qui en est atteinte." 

This condition of perfect insusceptibility manifests itself by 
the cessation of the symptoms of morbid reaction, and by the 
apparition of those which indicate an almost total inaction, as 
absence of natural warmth, colour, pulsation, secretions, sen- 
sibility, and in a word, of all organic and animal movements; 

* It is a fact worthy of notice, that the intellectual faculties continue in 
good condition even to an advanced epoch of the paralytic stage ; and 
that their alteration, or rather cessation, takes place tranquilly : a cir- 
cumstance which also confirms, that the nerveo-splanchnic system is that 
eminently, and I would say exclusively affected. The spasmodic condi- 
tion of the irritable organic and animal system concurs in support of this 
opinion, because we know from experiments made, that the irritability of 
any one part is in the direct ratio of the abundance of the sanguineous 
system, which is governed by the nerveo-splanchnic nerves, and by them 
accompanied until its last divisions. All those facts lead also to a deci- 
sion in favour of those who hold that the nerveo-splanchnic system has 
an existence independent of the sublime sphera, with which it merely 
communicates. 



the only remaining sign of life being an almost imperceptible 
respiration, which soon terminates in death. 

From what has been said, this malady may with someadvan- 
age be divided into two very distinct periods, of which the first 
commences at the moment of the attack, and lasts until the ter- 
mination of the spasmodic symptoms, which I shall call the ere- 
thistic, spasmodical epoch, or the period of reaction. The second 
period which, from the apparition of opposite symptoms, 
continues until death, and to which I will give the name of 
paralytic period, or period of inaction. It is not improper here 
to observe, that this disease assails the patient from the first 
moment of its attacks with so much rapidity and vehemence, 
that it may be said to come unpreceded by any premonitory 
symptoms. 

The results of dissection serve further to explain these phe- 
nomena. No alteration of structure has ever been discovered 
in any of the organs, which could be fairly imputed to this 
malady ; if such an instance of disorganization has occurred 
amongst the multitude of cases, it is rather to be ascribed to 
some preexisting organic disease ; and there has been observed 
in the muscles of the extremities that peculiar rigidity which is 
found in those who have died by tetanus ; some spots on the 
skin indicating local congestion or effusion ; injections, particu- 
larly in the cavity of the abdomen and thorax, which proves 
no more than that the blood, as is ordinarily the case, is 
amassed in the part where the reaction was the strongest ; the 
heart and lungs are flaccid, and filled with black and fluid 
blood, signs of the paralysis of those two organs. The 
stomach is ordinarily contracted, sometimes relaxed ; partial 
constrictions of the bowels take place, invagination and in- 
jection of black blood ; contraction of the gall bladder, and 
of the urinary bladder, which indicates a spasmodic state of the 
fibre. There is also found a certain quantity of mucus col- 
lected in the alimentary canal, which is considered as the effect 
of the spasmodic contraction of the capillary system, that 
excretes this humour, which, no longer finding room in the 
capillary reservoirs, is forced to expand itself, and overabound 
jnthat place which nature intended it to supply. The contrac- 



6 t 

tion of certain parts, and the relaxation of others, depends on 
the particular construction of each, and consequently on the 
different degree of their reaction. 

Putrefaction is ordinarily speedy, as is observed in all 
cases when violent death is occasioned by a rapid and power- 
ful shock of the nervous system. 

The exposition which I have made enables me to maintain, 
that the morbid process occasioned by the reigning malady is 
in its character preeminently nervous, and I should not scruple 
to class that malady with those fevers called fehres larvatce, and 
to entitle it Febris perniciosa larvata cliolerica. 

It may be termed pernicious, from its assailing its victim 
suddenly and without any known cause, to the manifest danger 
of life. It differs from all other fevers of that kind, by its 
higher degree, bringing death with a single paroxysm, whereas 
in other fevers of that nature, it is sufficient to be aware of 
their pernicious character, in order to save from certain death 
those who are unfortunately seized with it. One may add the 
title of choleric from the vomit and diarrhoea being the earliest 
and principal symptoms which are observable : because the 
name of cholera indicates nothing more than the form of a 
disease, which may as well be sporadic, and produced by 
other causes ; the epithet of larvata serves to indicate that 
the febrile symptoms are masked by the prevalence of the 
nervous ones in intensity and number. 

The morbid reaction then of the fibre, which may be con- 
sidered as the immediate effect of the general exciting cause, 
is ordinarily so intense, that in the first paroxysm it deprives 
the machine so entirely of its powers, as to leave neither time, 
nor means for it to collect its remaining active force, through 
which, assisted by art, it might be restored ; I say ordinarily, 
because amongst the varying degrees of intensity in the 
morbid process, there may be some which will admit the pos- 
sibility of an effectual cure ; still such rare cases do not leave 
much hopes, because the patients are easily attacked by a 
second paroxysm, which is fatal, and those who survive the 
cholera, frequently fall victims of the typhus, (another circum- 
stance which proves the nervous character of this malady) 



which likewise needs all the succours of nature and art. It is 
not extraordinary that this latter distemper should complete the 
destructive work where all the circumstances unfavourable to 
a successful cure exist. No one who reflects, that in pernicious 
affections little or nothing can be obtained by art during- a pa- 
roxysm, and whatever can be hoped, must be expected from na- 
ture, will consider as an exaggeration what has been above said. 

Causes. 

The direct cause of this malady is unknown in spite of the 
most minute observations which have been bestowed upon it ; 
nor has any thing been discovered sufficient for the forming of 
an opinion or hypothesis. 

Its prevalence notwithstanding has been observed in Europe 
in proportion to the prevalence of unseasonable and long con- 
tinued cold and damp, and it has also been seen to pursue the 
course of water, and to remain longest in those soils which 
are low, flat, humid, and populous. Zimmerman has remark- 
ed, that northerly winds have been the most common in Europe 
for a century past, which has been taken for the cause of many 
convulsive affections which have been so frequently observed, 
and peculiarly in the southern parts, since the extraordinary 
prevalence of those winds. The sudden and rapid changes 
of temperature to which the human frame is exposed when 
rendered most susceptible by the natural heat of the climate, 
explains the cause why the cholera, when it visits the southern 
countries, is sometimes more fatal than in the northern. This 
opinion, that the long prevalence of winter weather is one of 
the concurrent causes of this epidemic, might be supported by 
the advantage derived from all those means which tend to keep 
up a constant and active perspiration, such as the use of flan- 
nel and tea, apropos of which it has been observed, that in 
those countries where the use of tea is habitual, either the 
disease has not appeared, as in Holland, or it has not been so 
fatal, as in England. The same author says also that every 
season has its peculiar character, which consequently changes 
our humours in a certain degree, as has been observed by 
Hippocrates. Behold the cause of diseases peculiar to each 



8 

season. If the deviations of the seasons be excessive, epi- 
demic diseases, strictly so called, result. 

Disposing and determining causes. 

One of the essential and necessary conditions of all diseases 
is the predispositon towards it. The disposition towards spo- 
radic disease, may be found in the prevalence of some one 
or other organical system, modified by the circumstances of 
age, sex, physiological epochs, habit, &c. &c. ; but in the 
diseases proceeding from any general cause, the predisposing 
conditions are not discoverable ; for we find attacked by the 
latter, individuals of all kind of physical constitutions, and 
under the most opposite circumstances. Thus some have been 
attacked who were sound, robust, and perfectly temperate ; and 
others escape notwithstanding all the disorders which concur 
in constituting so many determining causes, the principal 
whereof I shall treat under the head hygeian. It is also cer- 
tain that these causes may increase or originate the disposi- 
tion, and more in proportion to their intensity, duration, and 
number. 

Cure. 

Here it may be proper to refer to some of the most remark- 
able opinions of my colleagues who were at Warsaw with the 
same object as myself, in explanation and corroboration of 
my own opinion. Some considering the blood as the natural, 
principal, and general stimulus of the organic fibre, and con- 
sequently as the principal cause and effect of all the vital 
movements, have attributed the morbid process to the want of 
oxygenation in the blood, which thereby losing its faculty of 
natural stimulus^ produces, like narcotic poisons, that which 
is called asphyxia of the heart ; and they therefore propose 
the use of oxygen as a remedy. 

"Whilst we cannot deny the physiological part of this rea- 
soning, still we cannot admit as a just corollary the induction 
of the pathological part of it, since we know the hamato- 
poesiSj like all the other functions, to be the effect of a vital 
process differently modified ; which vital process being altered, 



9 

the nature of its products, and consequently of the blood, be- 
come also changed, the diseased quality whereof is to be con- 
sidered as an effect, and also it may be said as an accessary 
and secondary cause, which does not admit a direct cure of 
the principal disease. Whoever would have full assurance of 
this fact, i. e. that the alteration of the blood is secondary, has 
only to take an animal, a rabbit for instance, and laying bare 
the pneumo-gastric nerve, to cut or tie it, and then it will be 
seen that the respiration being thus altered, the blood will still 
preserve its venous quality. 

There were some also who made much use of calomel ; with 
respect to which, if it was administered, with the same inten- 
tion as it is advantageously employed in nervous diseases of a 
chronic nature, whereof the course is long and indeterminate, 
where I have myself administered it with much success, still 
every one ought to know sufficiently the effect of this medicine 
to see that it should not be used in the case of cholera ; this 
disease requiring a prompt and energetic treatment by medi- 
cines adapted to sustain and to give direction to the operation 
of nature : if administered, as some say, to re-excite the sup- 
pressed secretions, this is only aiming at a symptomatical cure, 
and losing sight of the principal disease. 

Others also, considering the disease as consisting in a sus- 
pension of the secretions, propose the use of drastic, diuretic, 
sudorific mixtures, which can amount to nothing more than a 
symptomatic cure. 

Some holding to the principle, "Contrariis contraria, curan- 
tur" administer emetics in all cases, and thus they diminish the 
suffering of the patient by accelerating his death. 

Lastly, some assert that the essence of the disease consists 
in an inflammation of the alimentary canal. 

Every one knows that if that were the case, it would not be 
possible to deceive oneself in the diagnosis ; since, for an in- 
flammation to produce violent death, it must be of such force, 
and manifest itself with such abundant symptoms, as to need 
no professional eye to discern it ; and it will exhibit the signs 
of great disorganization. Topical pains will be consequently 
observed so great that the patient will be unable to support 

2 



io 

the slightest weight or pressure upon the abdomen ; general 
irritation ; characteristic pulse of this kind of inflammation, 
viz. small, constantly hard, tense, and frequent, the tongue 
very red, Stc. he; and, finally, a very high degree of inflam- 
matory fever ; and on the dissection of the body will be found 
gangrene of the part affected, the usual consequences of a vio- 
lent inflammation. 

The injections which are observed in the viscera of the cavi- 
ties of the body are adduced as proofs of this opinion ; but in 
consequence of that, I have already said, this symptom may 
be considered as the effect of a simple congestion ; but little 
regard should be paid to this sign, considering the force of the 
disease, and the absence of the principal symptoms character- 
istic of the pretended inflammation. Finally, as it respects 
bleeding, all the physicians who have treated this disease in 
Warsaw, have been convinced of the dangerous consequences 
of it. If bleeding has not been sometimes dangerous, it is 
not a proof that it may be always advantageous, nor that it 
is constantly used as anti-phlogistic ; because bleeding once, 
without availing of the other anti-phlogistic means, can never 
complete any cure of a declared inflammation. Besides, if 
bleeding is frequently diaphoretic, that is to say, if it favour 
the expansive movement, and with it the affluence of blood 
towards periphery, it is not necessary for that, to use in 
every case of this sole means for the only purpose of exciting 
the perspiration, and still less when the loss of any humour too 
interesting to animal economy is very dangerous, as in perni- 
cious paroxystic affections ; and no one could allege one case 
of successfully repeated bleeding. In my country, where per- 
nicious fevers are so numerous, no physician bleeds even where 
it could be symptomatically indicated. Dr. Searle himself, 
who has observed the cholera in India, and treated it in War- 
saw, has always had unsatisfactory results from bleeding. 

I would not, however, be understood as meaning to exclude 
the possibility of an inflammation consequent upon the pri- 
mary disease. That would be to show myself unacquainted 
with the theory of the new restorer of medicine (Tommasini), 
and to go against the facts exhibited by the diseases that follow 



11 

the intermittent fevers ; such as chronic inflammations, parti- 
cularly of the abdominal viscera, with their various issues, as 
physconia of the spleen or liver, phthisis of the latter, abdo- 
minal or catholic dropsis, obstructions in the omental lym- 
phatic system, &c. &c. ; but I can never admit as the essence 
of the disease, and principal cause of the death of a choleric 
patient, the inflammation of the digestive system. 

It may be objected to me that I place this disease in the class 
of fevers ; but the fever is not always symptomatic. I would 
be understood to speak of fever which is essential, idiopathic ; 
of this we have no other definition than that deduced from the 
symptoms, which exist in the cholera; but they are of short 
duration, being very soon followed and overpowered by the 
nervous symptoms, which mask the presence of the fever ; and 
it is for this reason that I have added the term larvata. 

It will be seen from this, that I do not consider the fever as 
always symptomatic, or as the effect of local inflammation ; but 
as being- in some instances, as has been already said, the cause 
of inflammation. I will further observe that the paroxystic 
fever never assumes the inflammatory character, except when 
some local inflammation generated by the fever itself, makes 
it assume that character, and then also the type is changed 
from intermittent to remittent (conlinua remittens.) 

I am of opinion that the essence of intermittent fevers con- 
sists in an irritation of the nervous-splanchnic system ; the inter- 
mission being a property which belongs to irritation, and 
distinguishes it from the inflammation, which admits no inter- 
ruption in its course when it has once manifested itself with 
its true and characteristic symptoms. 

Although the inflammation be the principal and most fre- 
quent consequence of the action of a morbid stimulus followed 
by morbid reaction, and as such, the cause more or less indirect 
of death, it does not therefore follow that sometimes the stimu- 
lus by its extremely heterogeneous quality or from its excessive 
quantity may occasion such a disorder in the vital powers as 
to produce immediate death. If death should happen suddenly, 
by the action of lightning, by a violent electric shock, by a 
poison such as theprussic acid, or deleterious gas, by a surfeit, 



12 

or by strong and sudden moral impressions, he. &c, why 
might not the same thing be affirmed touching the epidemic 
cause of the cholera ? If this be not the case, how otherwise 
explain the suddenness of the death of some choleric patients ? 
And how could this supposed inflammation consist with the 
rapid and violent course of the distemper without effecting any 
disorganization ? how consist with its easy and prompt reci- 
divation ? how with the acknowledged evil effects of the anti- 
phlogistic treatment in all the paroxysm, and the advantages so 
well known of the tonico-stimulants in the second stage of the 
disease, and in the state of convalescence ? 

From what is above said, and from the support which this 
view of the subject receives from positive facts, I have come to 
the conclusion, that a reasonable method of cure might be 
deduced. 

I have said that the first period should be considered as a 
state of a morbid exaltation of the fibre. Professional men 
know that in the case of such affections (paroxystic), the use of 
internal medicines is rather shocking to nature, which must be 
directed and not forced, and consequently the most powerful 
means consist in revulsions for that purpose : 

1st. Of establishing a point of counter-irritation in some 
less noble part. 

2d. To free by this means the central organs from the 
oppression caused by the great affluence of blood towards the 
centre, which may well be in itself an injurious secondary cause. 

The means of effecting this are known : I must therefore, 
notwithstanding, observe, that it is absolutely necessary to 
employ from the beginning the most active, because the others 
will produce no reaction, and besides in such diseases a middle 
course is at least useless, and time is above all things precious. 
It consequently becomes necessary to have recourse to the 
use of the moxa, applied particularly to the back, breast, and 
abdomen ; put the hands and feet in very warm lye, &c, and 
sometimes even hot iron must be employed, the great advanta- 
ges whereof are known in the history of medicine and surgery, 
and of which the use can never be sufficiently recommended 



13 

in the first attack of the cholera, it being entitled to the first 
rank in the class of pervertents and confoundents in pernicious 
paroxystic affections. 

Care must be taken also to keep the body of the patient 
warm in every manner. 

The air of the chamber should be kept pure, by producing 
a constant change in it, which may be done by means of a 
strong and blazing fire. 

With respect to the internal cure, the principal object will 
be to moderate the too violent action of the fibre, which may 
be effected by a well directed use of anodynes. 

Among these the preparations of opium are to be perferred as 
most grateful to the stomach ; and amongst the different pre- 
parations the laudanum liquid of Sydenham is to be preferred, 
not only for its liquid form, which is the most convenient, but 
'also because in this preparation there are other ingredients 
which increase the activity of the opium.* 

This medicine should be administered in large doses, but 
with some involvents, to prevent the too violent action of the 
narcotina, and maybe aided by the addition of some other anti- 
spasmodic. 

Warm drinks should also be given for the purpose of intro- 
ducing into the stomach the principal anodyne, and one of the 
first elements of life, which is warmth. Therefore small and 
frequent doses of warm and very weak mint tea, &c. he. should 
be given. Nor should the use of warm, emollient, and seda- 
tive clysters be neglected. 

The internal use of the stimulus which is hurtful in the first 
stage, becomes useful in the second, during which application 
the respiration of pure air must be continued. 

* I inscribe here the recipe of the laudanum liquid of Sydenham, because 
in this country the simple tincture of opium is frequently given for it. 
jgi Opii puri minite triturati . . . vncias duas. 

Croci sativi unciam unam. 

Corticis cinnamomi ruditer contusi drachmas duas. 

Omnia simul infundantur per tres dies leni calore in 

Spiritus vini recificati . . . uncias tres 
Vini Hyspanica libram . . . unam. 

Infusione facta filtretur liquor, et serbetur ad usum. 



14 

So also good use may be made in this period, of medicines, 
of which the benefit in similar cases is known, such as sulphas 
chinince, piperina, strychnina, administered also endermically 
and by clysters, in which the bark may be used in substance. 
Administration of an electric current may be also experienced. 

I have already said that general bleeding is hurtful. Nor 
must abuse be made of the general warm bath, because the 
consecutive weakness is not always compensated by per- 
spiration, which is the only object in its employment. 

If the physician be so fortunate as to see his efforts crowned 
with good results, he will have already gained much, but he 
will not yet have placed his patient out of danger. He must not 
be deceived by appearances of convalescence however promis- 
ing. It is during that period of seeming health, that nature 
collects all her powers to meet a relapse, which is ordinarily fatal. 
Sometimes recidivation of paroxysm is prevented by an inflam- 
mation, which usually attacks the nervous system, which, as we 
have seen, is eminently affected by the cholera.* This inflam- 
mation manifests itself under the form of typhus, a term derived 
from the greek word tufas, stupor, and which merely indicates a 
form of disease. That this typhus is of an inflammatory 
character, is proved by its course, the nature of its symptoms, 
the utility of the anti-phlogistic treatment, and above all, by 
the dissection of the body, which shows injections of the great 
nervous branches and thickness of the neurilema ; in the mem- 
branes of the spinal marrow and of the brain ; enlargements, 
and effusion of the lynpha plastica ; an abundant collection of 
serum in the ventricles of the brain, he. all manifest signs of 
a morbid dynamico-organic process. This disease may be 
considered as dangerous as the cholera itself, and therefore 
physicians must be on their guard, and persist in the most 
active revulsive method, as by cupping, with scarification, and 
the application of leeches to the forehead, behind the ears, 
and on the back ; which, besides the advantage derived from 
the local subtraction of the blood, serves to maintain a point 
of counter-irritation in the peripheric organs. The contem- 

* Casimir Perier furnishes us with a distinct example of this : his re- 
covery from cholera having terminated fatally in brain fever. 



15 

poraneous and prudent use of the sulphas ckiniiw should not 
be omitted, because its action, although not understood, has 
proved a specificin such diseases, and will also assure the patient 
against a second paroxysm of the cholera. What has been said 
of the inflammatory typhus, may be applied with due modifica- 
tion in the inflammation of any other part disposed to it by 
particular circumstances. 

Assured that the danger of any inflammation is past, abun- 
dant use of the sulphas-cliinina should be continued, joined 
with a restoring diet and wine. 

It is useless to say that the prophylactic means should be 
more religiously observed by those who escape death, after 
having been attacked by the cholera. 

1 do not propose such remedies as exclusive ; I mean only 
to speak of the indications from which a good method of cure 
can be deduced, which may be effected by various means lead- 
ing to the same end ; but whatever may be the means employ- 
ed, the prompt and diligent use of them cau never be too much 
insisted upon. 

If there are few or scarcely any advantages to be derived 
from medical treatment after the developement of the disease, 
then the best way of diminishing the effects of the epidemic 
will be to prevent every thin"* that might favour its influence, 
and this will be obtained by a good 

Hygien. 

In considering the matter under the above aspect, not only 
may a means of cure be determined, but it will likewise be 
much more easy to discover the accidental causes which favour 
the progress of the disease, and increase the disposition towards 
it, and thus be enabled to establish rules which may, to a cer- 
tain degree, protect us from it. 

The nervous system being that pre-eminently affected, every 
thing that tends to disturb its wonted regularity, may furnish 
so many causes determining the predisposition. 

In distinguishing the determining causes into external and 
internal, among the former may be classed those which act 
upon the principal organs of the kcematopoesis (the skin and 
the lungs), and of the chylopoesis ; that is to say, cutaneous 



16 

and mucus pneumo-gastric system. Nature employs these 
two systems to dispose over a vast surface the means of main- 
taining the relation of the individual body with the external 
world, and preserving the equilibrium of the individual and 
reciprocal functions ; the alteration whereof may, in the time 
of an epidemic, exhibit itself in a peculiar form, determined 
by that epidemic itself. The means above spoken of as those 
whereby nature obtains its salutary ends, are the last divisions 
of the nervous and vascular system. Consequently, in rela- 
tion to the system of perspiration, respiration, and also of 
digestion, the action of cold will be dangerous; and if humid, 
still more so. This latter condition of the atmosphere, exer- 
cises a particular influence over the nervous system, as is 
proved by that state more or less observable of physical and 
moral uneasiness experienced during moist weather, and the 
susceptibility for nervous and rheumatic pains, exacerbations, 
or reapparition of certain diseases, &ic. &c. 

As to the system of digestion, the stomach being, as one of 
the organs most necessary to life, nearest to the centre of ac- 
tion of the organical functions, the plexus Solaris; and also in 
sympathetic relation with all the other organs, it is not sur- 
prising if, as has been frequently seen, disorders of this viscus, 
prove so many causes, above all others, determining the dis- 
position. 

Among the internal causes should be chiefly remarked the 
moral affections and diseases. By what has been said, it may 
be judged which are the pre-existing diseases, which chiefly 
dispose to the cholera. These are dyspepsia, a term which 
denotes no more than a form of disease ; various affections of 
the nervous system, particularly the intermittent and nervous 
fevers ; typhus, Sic. ; and the state of convalescence from 
acute disease, as I have had occasion to observe at Warsaw. 

Among the moral affections, the principal is the fear of the 
disease. If a strong impression has been sometimes the cause 
of a sudden death, why may it not be a cause disposing to 
the cholera ? poverty and want are also principal sources of 
depression. 

It will therefore be necessary, 

1st. To have no fear of the disease: to have no belief in 



17 

its contagiousness is certainly a great advantage, as it dimin- 
ishes the probability of being seized by it. 

2dly. To avoid exposure to sudden changes of weather : 
to preserve the skin constantly in a regular condition ; that is, 
in a gentle perspiration by known means, among which the 
most important is the use of flannel upon the naked skin. 
Above all, in summer time, the precaution must be observed 
of keeping the feet constantly warm ; I say in summer, be- 
cause in this season the morbid reaction of the internal organs, 
caused by the altered equilibrium of the cutaneous functions, 
is chiefly excited in the gastro-epatic system, as it is demon- 
strated by the sudden cholics, dysentery, and jaundice pro- 
duced by suspended perspiration in the feet. The night air 
is very dangerous, because usually both cold and damp. 
These precautions are chiefly necessary in maritime cities, on 
account of the frequent changes of the winds. Thus also 
the use of tea can never be sufliciently recommended. 

3dly. As to the regimen of nourishment, it should be suffi- 
cient, but not excessive ; for great is the number of cases which 
proceed from the disorders of the table ; as too long fasting 
produces morbid hunger, so the too eager gratification of 
that craving appetite is equally scrupulously lo be avoided. 
As to the quality of the food, it should be nourishing and easy 
of digestion, excluding entirely fat meat, and vegetables which 
contain much vegetable water, as cucumbers, melons, water- 
melons, gourds, pumpkins, and all raw and unripe vegetables, 
sallads, radishes, &;c. &c. And all green sour fruits, particu- 
larly such as the climate does net suffer to ripen ; those which 
have undergone concoction are less hurtful, as is the case with 
all aliments.* 

* And whether it be consistent with a due regard to health to feed 
upon meats so nearly raw, as those which are so much relished in Great 
Britain, and the countries which follow its usages, is a question which is 
worthy of attention. 

It is an error to believe, 

1st. That meat, when much cooked, loses its nutritive qualities. 

2d. That when almost raw, it tends still more to fortify the stomach. 

The first of these opinions is erroneous, because the nourishment is 
furnished by the food whereof the quality is not changed by cooking j 
but on the contrary, the cooking renders it more nutritive, and advances 
the operation of nature, instead of obstructing it. One of the principal 






18 

Every one should avoid the use of those substances with 
which his stomach does not sympathize idiosyncratically. . 

Inasmuch as the use of good, pure and old wine at meals i& 
good, so is that of new wine, cider, new or poor beer, and the 
abuse of all sorts of liquors pernicious ; as is also that of very 

objects of digestion is to reduce the solid substances to a certain degree 
of liquidity, a necessary condition to the action of the capillary extremi- 
ties, destined to absorb the nutritious part, a condition which is favoured 
by the process of cooking ; for as the harder substances which cannot 
be acted upon by the mechanico-chemico-dynamic action of digestion^ 
and must be expelled from the digestive canal entire, they are therefore 
not only a useless but a dangerous incumbrance, by requiring too strong 
an effort of the stomach. From the same cause, rear meats are still more 
prejudicial where soup forms no part of the repasts ; for besides other 
advantages, soup has that of containing water, which is the principal sol- 
vent employed by nature. 

As to the second point, the stomach is weakened instead of being: 
strengthened, in consequence of the stronger action which it is obliged 
to exercise upon the flesh so nearly raw, in order to effect what the fire 
would have done, and to supply the imperfect effort of mastication. 
Thence the necessity of medicines, drugs, and strong liquors, with the 
idea of exciting lost appetite, and promoting digestion; thus accumu- 
lating the causes which produce dyspepsia, toothache, consumption, &c. 

The case would be different if man was still in his original, simple, 
and robust condition: but the degeneration which the human machine- 
has undergone through the influence of customs and social manners, 
which have become matters of necessity for those who have been born 
among, or have entered into the corruption of the age, this degeneration 
must have, of course, operated a change on the whole mode of being. 
Besides, if the use of this nearly raw flesh was so salutary as is sup- 
posed, why then has nature furnished us with teeth, and the instinct of 
chewing ? why do those irruptions so frequently occur, and sometimes 
even rumination, in human beings? and why do the aged lose their teeth 
at that season of life which is characterized by its weakness, and why 
do they incline to the use of substances which are most tender, and some- 
times of liquids only? may we not see in that a warning, which nature 
gives, that the stomach is too weak for the digestion of substances that 
are too solid ? and in the case of children, why is it, that in their most 
tender ages they are without teeth, and that it is not until they have ac- 
quired more strength, that nature operates a change by presenting them 
with a new range more suited to their growing strength ; and the instru- 
ments of mastication are most perfect at the time of life when the powers 
of digestion are most vigorous ? why are the powers of mastication with- 
held or withdrawn at those extreme periods of life when such food as is 
not easy of mastication and digestion, is equally unsuited to the feeble 
state of infancy, or the used and decayed condition of old age? And again, 
if it was intended by nature that man, like the carnivorous beasts of the 
forest, should eat raw flesh, why are not their canine teeth developed to 
the same degree, or the digestive powers as great ? And in the case of 
the birds of prey, in which prima non Jit in ore digestio, let us examine 
the digestive system, and it will be seen how nature has supplied the 
absence of the teeth and salivary glands by a very strong and eminently 
fibrous stomach, with juices extremely solvent, and by a pancreatic 
gland, greatly developed, to effect the purpose of the saliva. The same 



19 

cold drinks in whatever time or circumstances, as sherbet, ice- 
water, he. For common drink, I should prefer spring water 
corrected with wine, brandy, lemon, sulphuric acid (one drachm 
in twenty-four ounces of water), he. 

We should not immediately after meals engage in any seri- 
ous occupations, which are better left to their appropriate 
hours ; nor to turn night into day, nor day into night ; in short 
it is necessary to avoid all kind of excesses and abuses, and to 
preserve ourselves in a moderate and natural state of excite- 
ment. 

4th. Use should be made, and particularly in cases of weak 
and susceptible constitutions, of medicines which serve to re- 
inforce the stomach, and give tone and vigour to the nervous 
system. 

5th. It is important to breathe pure air, of course to change 
it often in the chamber, particularly of the patients, and to 
avoid humidity, and crowded assemblies of all sorts in close 
and ill situated places, particularly such as are exposed to the 
effluvia of stagnant waters, foul places, stables, he. It will 
be very beneficial to purify the air of the habitations from time 
to time with chloride, of which the development will be obtain- 
ed in small or ordinary private houses by a vessel containing 
an ounce of chloruretum calcis, and three pounds of water, 
or better with the disinfecting bottle of Guyton ; and in such 
public buildings as are most disposed to decompositions, and 
putrid fermentations of organic substances, as hospitals, mar 
kets, he. he. where a more prompt, and abundant development 

might be said of avast variety of instances in the animal kingdom, which 
here we will not enumerate. 

But confining ourselves to humanity, and to facts thereto exclusively 
referable, let us compare the different customs of different nations, and 
it will be seen whether in the countries where nature is consulted in 
regard to health, the toothache, which in most instances proceeds from 
an affection of the stomach, dyspepsia, piles, gout, scurvy, consumption, 
hypochondria, and above all, prematuie deaths, are so frequent as they 
are found to be among the English; if it be said, that all this may be 
the effect of climate, I answer, that the evil influence of climate will be 
increased by circumstances that are entirely dependent upon the will 
of man. And if this mode of living is in general bad, it is worse for 
those who lead a sedentary life. The gout is, as it were, endemical in 
England, and is always the accompaniment and consequence of disor- 
ders in the digestive system ; and this simple circumstance might in some 
degree justify the abuse which is made of calomel and soda-water. 



20 

of the chloride is necessary, there should be exposed in a ves- 
sel over the fire of 

Common salt - - - - -5 parts 
Manganese --,■'..'*•-■•-. I part 

Sulphuric acid, diluted with 2 parts of water, 3 parts 
The chloride is disinfecting from its property of destroying 
miasmata by removing the hydrogen from them, which by 
changing it into hydro-chloric acid gas, neutralizes the am- 
monia which, with hydrogen, enters into the putrid animaland 
vegetable exhalations. 

But above all, the greatest cleanliness should be observed, 
and every thing removed which tends to generate miasmata. 

In case the authorities of the different countries shall be dis- 
posed to employ the means of public utility, the best will be : 

1st. To enforce the observance of the greatest cleanliness in 
the cities and towns, and especially where population is most 
dense, and in the vicinity of stagnant water. 

2d. To recommend the use of disinfecting substances (as the 
chloride) in private habitations, and to enforce it by the laws 
in public institutions where it is absolutely necessary. 

3d. To show the unwholesome effects of a crowded popula- 
tion in a contracted space ; to provide against this evil where 
it is necessary with the public purse, and to assist in giving 
employment to the poor and industrious classes. 

4th. To shut up the theatres, and to inculcate a less frequent 
attendance in the churches. In such exigencies the first are 
useless, and the second not necessary: the same thing may be 
said of all tippling houses, and places of debauch and dissi- 
pation. 

5th. To have the dead buried far from the habitations of the 
living. 

6th. To establish temporary hospitals (wood buildings) in 

suitable places, in elevated -and isolated situations and where 
there is a free current of air, and trees. 

These hospitals will serve, 

1st. To administer medical aid to the poor. 

2d. To establish a central point for medical observation. 



21 

3d. To administer with the greatest promptitude the means 
of cure : and in this view it might be well, if the wealthy 
classes would unite in procuring a building, furnished with all 
things necessary for the reception of those who would be 
assured of the most intelligent, skilful, and diligent attentions, 
which is impossible to be obtained in any private residence ; 
this project, beside the said advantage of being taken better 
care of, will be preferable, since without preventing the rela- 
tions from visiting the patients, it would be the means of avoid- 
ing the evils which the presence of the person affected by 
cholera would occasion in his family. 

It is true that, generally speaking, the cholera attacks the 
poorer class, in preference. But it has also been observed, 
that where its influence has been very strong, no class has 
been exempt. We do not yet know, in case the cholera should 
exhibit itself in North America, what may be its intensity. 
We know, however, that where the distemper, known by the 
name of influenza reigns endemically, it is experienced by 
every class with sufficient force. 

Cholera Morbus is not contagious. 

The intrinsic nature of the general morbific cause being 
unknown, no better epithet can be applied to the cholera morbus 
than that of epidemic, which serves at least to designate its 
principal feature observable by the senses ; that is, its being 
general, which this word expresses by its Greek derivation, epi- 
demos, upon or over the people. This best distinguishes it 
from endemic, in the people ; which applies where the cause is 
local, and confined to a certain portion of the earth. This 
last indicates, that the circumstances which give rise to the 
development of the morbific cause, are found in the topo- 
graphical condition of a country ; constant and invariable 
(such as mountains, water, valleys, plains, prevalent winds), 
or accidental (such as ^manufactories, populousness, certain 
kinds of agriculture, shops, he), and that these circumstan- 
ces assist in the study of the different morbific causes from 
which may be drawn useful applications, with the most lumi- 
nous results, as was instanced in the immense advantages 



22 

derived from draining the Pontine marshes in Romagna, the 
stagnant waters in the department of Mantua, and in other 
provinces of Lombardy, and in plantations made upon them ; 
which have eradicated in those regions the malignant inter- 
mitting fevers, which have appeared in those places, where the 
plains have been inundated for the cultivation of rice, or the 
formation of artificial meadows. This could not have resulted 
from an epidemic, which does not furnish us with material facts, 
from which to deduce useful and satisfactory reasoning. How 
can the medical observer investigate the character of this epi- 
demic, when up to the present time no remedy has been dis- 
covered against its effects, its nature being so imperceptible 
and fugitive, as to render all precautions vain, though taken in 
time, against the propagation ? For myself, I conclude that 
the cholera morbus is simply epidemical, and may be proved 
such by reasoning and facts. The best reasoning is that 
drawn from an attentive examination of material facts, relating 
to the properties of diseases. From an examination of the 
properties of those which are truly contagious it will be 
ascertained whether the cholera morbus belongs to them. 

Those particular animal fomites are called contagions, which 
are produced in the animal organization when diseased, in a 
determinate form of malady ; these by coming in contact with 
other individuals, produce at least an analogous form of dis- 
ease ; besides the material vehicle, they have also an immate- 
rial one of an unknown nature ; these fomites occasion a 
phlogistic process in the skin or mucus, by which process they 
are reproduced (this is the characteristic of perfect contagions) ; 
they affect the organization all at once by exciting a critical 
fever of an inflammatory character; they never attack the 
same person twice (these two last properties constitute the de- 
finitive character of perfect volatile contagions, such as small- 
pox, scarlatina, morbillus, contagious typhuses, he.) The most 
minute observations have never discovered any trace of inflam- 
mation, or any of its effects ; such as a morbid secretion, which 
might be regarded as the vehicle of the immaterial principle ; 
as is manifestly observed in small-pox, pestis bubonica, dysen- 
teria castrensis, ophthalmia JEgyptiaca, &c. But allowing 



23 

that the inflammation may be so slight that the nervous symp- 
toms prevent its detection, so rapid in its course as to be unob* 
servable by the senses, so limited as to produce only the secre- 
tion of a natural humour, which may serve as the vehicle of 
the contagious fames, what hazards have not been encountered 
to ascertain whether the cholera is of a contagious nature or 
not? Repeated inoculations, both from the blood and the 
gastro-interic juices of living and dead sufferers have been 
made, both under the cutaneous surface and in the mucus, 
without any symptoms having been presented of the slightest 
morbid reaction. If these do not suffice, there are other facts 
in corroboration of those already mentioned. None of the 
physicians who engaged in the cure of those afflicted with the 
disease at Warsaw took it. None of the nurses, none of those 
who attended the patients in private houses, were attacked by 
it. How often have I myself personally administered pro- 
fessional attendance to the sick, who had been abandoned 
from terror by their relatives ! If in any family the disease 
broke out in several of its members, and at periods more or 
less distant, a sufficient reason for it was to be found in their 
being all exposed to the influence of the same determining 
causes ; among these, fatigue and distress occasioned by the 
war (in Poland), or by the selfish tyranny of the despot, whose 
last thoughts were for the happiness or health of the people. 
This is still more clearly proved from the known fact, that 
whenever any member of a family in affluent circumstances 
was seized with the malady, none of the others who availed 
themselves of the advantages of fortune without abusing them, 
were ever attacked. 

I have stated that another property of perfect volatile con- 
tagions is, that they cannot attack the same person a second 
time. But the cholera does reattack the same person as 
readily and as dangerously as before. 

If this malady be really contagious, why can there not be 
produced from the vast number of cases, incontestable exam- 
ples of the identical malady being generated by contact in 
any manner whatever, as is known to be the case in small- 
pox, which passes from one individual to another by inocula- 
tion, or by any other kind of contact ? 



24 

I have said, that the epithet of epidemic is more suited to 
the cholera of which I speak ; if it be so, why seek for an- 
other, and more imperfect one, in that of communicable ? 
because either the disease communicates itself by contact 
(which in no case happens), and then it would be better de- 
signated as contagious ; or if it be intended to express by the 
term communicable, that the producing cause has nothing in 
common with what belongs to the earth, except as it exercises 
its influence upon it, it would then be best to call it an epi- 
demic. If this be so, if such be the conclusion of the ma- 
jority of physicians who have observed the malady, why make 
use of a word which comprehends in itself a meaning as in- 
telligible as it is frightful? why compel the authorities en- 
trusted with the public welfare to adopt strong measures un- 
necessarily, such as cordons sanitaires, quarantine regulations, 
he. the inutility whereof has been plainly seen in the fact, 
that the cholera made its way into several German cities, in 
despite of the strictest cordons, which had been long establish- 
ed at all points of communication with those which had the 
disease ? 

Some contagionists hold, that the malady is reproduced and 
propagated by means of an exhalation, sui generis, from the 
bodies of the diseased ; but it is worth while to remember that 
what they call exhalation, must be the effect of a most vital 
process, showing itself in the cutaneous system which nature 
has especially intended for exhalations ; that exhalations of 
such a kind from a living body are ordinarly produced by 
some of the principal pathological conditions, such as conges- 
tion, irritation, inflammation, circumstances necessary to any 
morbid secretion whatever, in order to increase in quantity, 
and alter it in quality. On the contrary it is observed, that 
one of the most remarkable symptoms of the cholera is, that 
the skin partakes in the highest degree of the general spasmo- 
dic condition of the fibre, which deprives it of the power of 
exercising its functions ; it becoming, as it were, insensible, 
with no indication of heat (a circumstance necessary to the 
development of exhalation) ; in short, in a state of almost ab- 
solute inactivity. 



25 

They cite, in support of their opinion, the manner in which 
the cholera is propagated ; but this may be best explained by 
appealing to circumstances more or less powerful, either gene- 
ral or peculiar to certain localities favourable to its progress, 
without our being bound to consider it contagious ; since 
viewing the matter as they do, all epidemic maladies would be 
contagious only in consequence of their resemblance in some 
general circumstances. The facility with which a contagious 
malady may become epidemical, does not necessarily lead to 
the conclusion that an epidemic must be always contagious. 

So also its progressive advances in a given place may de- 
pend on its gradual increase in intensity, modified by the dif- 
ferent degree of violence, and number of general determining 
causes, as well as by the different degree of predisposition in 
individuals ; circumstances which clearly explain why the 
epidemic easily revisits the same locality, and why its effects 
are repeatedly manifested in the same houses. 

Nor is it extraordinary it should break out in ships, which 
combine together all the determining causes ; such as vitiated 
atmosphere, humid cold, bad provisions, scarcity of them, &c. 
circumstances which, combined with that of a ship's coming 
from an infected country, may lead to the belief, that it is itself 
a material vehicle for transporting the malady. 

Nor is it strange that this epidemy should have had, and 
has a predominating influence in cities situated near the 
water, as they are generally found to be in low, flat, foggy 
places, and thickly peopled ; the moisture being constantly 
supplied by marshes, which even originate the development of 
the miasmata produced by the decomposition of organic 
bodies ; miasmata which in the same manner as they become 
the cause of other malignant disorders, may easily be a vehi- 
cle, and even the means of reproducing the epidemic cause ; 
this makes the use of chloride very reasonable and prudent, 
it being disinfecting, for the reason already cited. 



26 



Questions. 

1st. Will the Cholera find its way across the ocean to North 
America . ?# 

Ans. It would be more probable if the disease were a con- 
tagious one, that it should not reach this country : for the 
atmosphere of the sea would be an obstacle to its arrival, and 
sanitary measures might prevent all intercourse with the infected 
countries. But the cholera is simply epidemic ; it has already 
passed over seas, and it follows the course of water and travels 
westward. 

2d. Should it pass the sea, and reach North America, will 
its effects be very destructive ? 

Ans. Those circumstances which are most favourable to its 
reaching North America, are no less so in regard to its force 
and progress there; and the frequency of death in this region 
from sporadic diseases, may be a means of judging of the 
effects of an epidemic disease. 

Principal differences between the cholera and yellow fever. 

Having once happened to be present at a conversation 
which took place at Pavia, between a Dr. Herman (who an- 
nounced himself as chief doctor of the marine of the United 
States in the Mediterranean — Medicin en chef de la marine 
des Etats Unis dans la Mediterranee), and Scarpa, to whom I 
had the honour of introducing him, and having heard the 
said Dr. Herman express his opinion in favour of the identity 
between these two diseases, I have been decided by that cir- 
cumstance, to show the principal points of dissimilitude between 
them. 

1st. The generating causes are different, as may be seen by 
the circumstances which accompany the two diseases, and by 
the effects which they produce ; thus the cholera has pre- 
vailed, it is admitted, in soils, climates, and situations where 
the yellow fever has originated, but the yellow fever has 

* This pamphlet was written about three months before the appearance 
of the disease upon the American continent. — Note of the Translator. 



27 

never reached to those latitudes and situations, nor subsisted 
in those degrees of cold where the cholera has exercised its 
most malignant and destructive energy. The yellow fever 
has never survived but in the season of the greatest heat ; the 
cholera has endured longer in the winter season and in high 
northern latitudes ; it has been very fatal also in tropical and 
warm climates, but chiefly so when they have been visited by 
unusual cold. 

2d. The regimen which is fatal in the one, is in the other 
preservative : thus the cholera requires the use of flannel, 
abundant and substantial food, comprising flesh, wine, and 
liquors. In the yellow fever flannel is of no use, the per- 
spiration being active, and a vegetable and cooling diet is 
necessary. 

3d. The morbid process in the respective diseases differs : 
thus in the cholera it is limited to a nervous affection, whereas 
in the yellow fever it manifests itself in a dynamico-organic 
process, that is to say, inflammation of the gastro-hepatic 
system, as is proved by the course of the disease, the method 
of cure, and by dissection : all which show that there is a 
difference not only in the nature, but in the intensity of the 
producing cause; that which produces the" cholera being so 
much the more intense, as it occasions death in a few hours, 
without intermediary process, such as inflammation with its 
various consequences, as is seen in the yellow fever, whereof 
the course at the shortest is never less than three days' duration. 

4th. Dissection : in the cholera are observed signs of 
spasm and congestion ; in the yellow fever are discovered 
manifest symptoms of organic changes in the gastro-hepatic 
system, &c. 

Thus in a few pages I have expressed my opinion on the 
most interesting particulars of this epidemy. If my manner 
of treating it should prove satisfactory, then has my object been 
attained, if not, I shall be glad that any one by more correct 
and just reasoning should show where I have been mistaken j 
because it is by inter-communication and a liberal exchange of 
ideas, that truth is brought to life. How often has error proved 
the basis of truth ! 



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